A qualitative study exploring the experiences of young women presenting to primary care in England with breast health concerns

Technical Summary: Experiences of Young Women Presenting to Primary Care with Breast Health Concerns

Problem Statement
While breast cancer (BC) incidence in the United Kingdom is increasing among women under 40, existing research on primary care (PC) experiences largely focuses on older age groups. Younger women (YW) often fall outside national screening programs and must self-detect symptoms to initiate referrals. Current literature suggests that younger age contributes to diagnostic delays, with young patients often requiring multiple appointments before referral. These delays are associated with advanced disease stages, poorer prognosis, and significant psychological distress, including anxiety and feelings of dismissal. However, there is a specific gap in understanding the unique experiences of YW (aged 18–40) presenting breast concerns to General Practitioners (GPs) in England, particularly regarding how these interactions impact their psychological wellbeing.

Methodology
This qualitative study employed a reflexive inductive thematic analysis (ITA) to explore the experiences of 11 young women (aged 18–40 at the time of concern) who presented breast health concerns to primary care in England and subsequently received a referral.

• Participants: All participants identified as cisgender female and were of White British ethnicity. Most (n=10) presented with a breast lump. Nine participants had one appointment prior to referral; two had two.
• Data Collection: Semi-structured interviews were conducted via Microsoft Teams between April 30 and June 4, 2025. The interview schedule covered the patient's journey, GP interactions, factors influencing referrals, and suggestions for improvement.
• Analysis: Transcripts were anonymized and analyzed using NVivo 15. The analysis followed the framework by Braun and Clarke (2006), involving familiarization, iterative coding, and theme generation directly from the dataset, with researcher positionality considered throughout.

Key Results
Three overarching themes emerged from the data:

1. Quality of GP Interactions and Communication:

   • Positive Interactions: Participants described GPs who were empathetic, friendly, and unhurried as making them feel "calm," "safe," and "empowered." Taking time to communicate and validate concerns was crucial.
   • Negative Interactions: Conversely, interactions described as "clinical," "grumpy," or lacking empathy led to feelings of being "belittled," "dismissed," or "degraded." Some participants felt treated as a statistic rather than an individual, with a lack of eye contact exacerbating feelings of dehumanization.

2. GP Provision of Information and Patient Impacts:

   • Symptom Causation: Information regarding the potential cause of symptoms was often scarce. While some felt this lack of detail was acceptable, others felt it left them without a sense of control or unable to advocate for themselves.
   • Referral Process: Variability in information regarding the referral pathway was noted. Those who received clear information about upcoming procedures (e.g., ultrasounds) felt more prepared. Conversely, a lack of information led to confusion, "unknown worrying," and psychological spiraling during the waiting period.
   • Desire for Transparency: Many participants expressed that increased transparency regarding procedures would reduce anxiety and restore a sense of control.

3. GP Symptom Management Communication and Patient Effects:

   • Reassurance vs. Lack of Concern: Even when referred, some participants felt a lack of concern from GPs, often framed by their young age (e.g., being told to "just chill"). While this reassured some, others diagnosed with BC later felt this was "false reassurance" that was misleading or anger-inducing.
   • Dismissal and Re-presentation: Two participants were initially dismissed, with breastfeeding cited as a contributing factor. A critical finding was the lack of explicit "safety-netting" (clear timeframes for re-presentation). This ambiguity left patients uncertain about when to return, leading to delays in re-presentation due to fear of being viewed as a "nuisance."

Key Contributions

• Focus on a Specific Demographic: This study exclusively examines the primary care experiences of women aged 18–40, a group often excluded from broader breast health research despite rising incidence rates.
• Psychological Impact of Communication: It highlights the direct correlation between GP communication styles (verbal and non-verbal) and the psychological wellbeing of young patients, noting that negative interactions can cause significant distress.
• The Role of Safety-Netting: The paper identifies the specific need for clear re-presentation timeframes, particularly for symptoms that may be initially attributed to benign causes like breastfeeding, to prevent diagnostic delays.
• Informational Needs: It underscores the variability in patient preferences for information, suggesting a need for tailored communication rather than a uniform approach.

Significance and Recommendations
The authors claim that understanding these experiences is essential for improving GP–patient interactions and mitigating the psychological harm associated with symptomatic consultations. The study does not claim to solve diagnostic delays definitively but suggests that optimizing the primary care encounter is a critical intervention point.

Based on the findings, the paper recommends:

1. Tailored Communication Skills Training (CST): GPs should receive training specifically focused on breast health concerns to improve empathy, non-verbal communication, and the delivery of nuanced reassurance.
2. Enhanced Information Provision: Practitioners should provide clear, flexible information regarding referral processes and procedures to reduce patient anxiety and increase feelings of control.
3. Explicit Safety-Netting: Clear timeframes for re-presentation must be established to prevent patients from feeling dismissed or uncertain about when to seek further help.

The authors conclude that while their sample size was small and limited to White British women, the findings offer novel insights into the emotional and informational dynamics of primary care consultations for young women with breast concerns, emphasizing the need for empathy and clarity to support psychological wellbeing.